| General
|
| Employment Application |
|
| Full Time Employee Check List |
Employee Handbook and Safety Manual |
| Part Time Employee Check List |
Summer/Part-Time Employee Handbook |
| Change
of Address |
| Human
Resource Info Form |
| Personal
Budget Spreadsheet (Excel) |
| |
| Credit
Union - Now USX |
Representative Contact: Renee Jessee 1 888 219 3159
Or by Email at RLJessee@usxFCU.org
|
| USX Enrollment Form |
USX Payroll Deduction |
| Vehicle-Personal-Loan-Application |
| |
|
| Employee
Payroll and Benefits |
| Payroll |
| W-4
(2024) |
Direct
Deposit of Paycheck |
| W-4P
(2024) |
Local
Services Tax Refund Application |
| I-9, Employment
Eligibility Verification |
Local
Services Tax Exemption Certificate |
| Earned
Income Tax Residency Certification |
|
| |
|
| Miscellaneous Employee Forms |
| Form
1000 Hire Authorization and New Position Request
(yellow sheet) |
| Form
2000 Employee Status Change Request/Notification
(blue sheet) |
| Form
4000 Accident Report (orange sheet) |
| Form
7000 Request for Outside Employment |
| Employee
Flex Time Policy and Request Form (11/09/2023) |
| Leave
Without Pay Form |
| Employee
Vacation Carry-Over Request Form |
| Employee
Expense Form (1/23/2024) |
| Fill-in
Employee Expense Form (Excel) (1/23/2024) |
| Physician
Certification for Family or Medical Leave |
| Continuing
Education Approval and Refund Application |
| Professional
Meeting/Seminar/Training Attendance Request |
| Employee
Observation Report |
| |
|
| Police Miscellaneous Forms |
| Police
FOP Deduction Form |
| Police
Union Dues Deduction Form |
| Police
Flower Fund Deduction Form |
| |
|
Deferred
Compensation |
| 457
Plan Salary Deferral |
| Mission Square 457
Plan - Client Services 1-800-669-7400 |
| Mission Square Retirement
Plan Representative - Erik Gabrich - egabrich@missionsq.org - Work #202-759-7018 - Work Cell #202-430-3688 |
| Mission Square
457 Enrollment |
|
| |
Capital Group / American Funds
(800) 421-4225 |
| 457
American Funds Plan Enroll |
| |
| Nationwide
457 Plan - 1-877-677-3678 www.nrsforu.com |
| |
Participation
Agreement 457(b) |
| |
|
| Disability
Insurance Benefits |
|
| Monroeville
Short Term Disability Form |
Application
for Disability Retirement |
| |
|
| Life Insurance |
|
| Aflac - Dan Marcin 412-826-1840 |
www.aflac.com |
| Conseco - 1-800-283-8075 |
www.conseco.com |
| Active Police - Life Insurance Enrollment-Change |
Municipal - Life Insurance Enrollment-Change |
| Standard
Insurance Group Life Policy |
|
| |
|
| Pension |
|
| Police Pension
- Debbie Rall - 412 562-8216 drall@janney.com |
| Nomination
of Beneficiaries/Instructions (Police only)
|
| Non-Police
Pension 1-800-622-7968 |
| Application
for Membership (Admin, Clerical, Public Works,
Refuse, Library) |
| PMRS
Notification of Change |
| PMRS website
- www.pmrs.state.pa.us |
| Employee
Pension Plan Summary (Non-Uniform) |
| |
| Workers
Compensation |
| Workers'
Compensation Employee Notification |
| Form
4000, Accident Report |
|
| Workers'
Compensation Provider Panel |
|
| Municipality
of Monroeville - The Workforce Protocol |
| |
| Ordinances |
| 2786,
Benefits, Monroeville Exempt and Non-Exempt Employees -- Long Term Disability Amendment to Ordinance 2630 |
| 2630,
Benefits, Monroeville Exempt and Non-Exempt Employees -- Admin Contract 2015 |
| |
|
|
2773, Police Collective Bargaining Agreement 2023 |
| |
|
| 2788,
SEIU Clerical Workers & TCO Collective Bargaining Agreement 2024 |
|
2716, SEIU Clerical Workers & TCO Collective Bargaining
Agreement 2019 |
| |
|
| 2787,
Public Works Collective Bargaining Agreement 2024 |
| |
|
| 2789,
Refuse Workers Collective Bargaining Agreement 2024 |
| 2747,
Refuse Workers Collective Bargaining Agreement 2021 |
| |
|
| 2198,
Military Leave Policy |
| |
|
| Library
Personnel Policy Manual 2019 |
| |
| Health
Care |
| Highmark
Blue Cross/Blue Shield Member Service Questions 800-241-5704 |
| UPMC Contact Info: UPMC Member Services 1-888-876-2756 |
| UPMC Health Advocate Assistance 1-866-695-8622 |
| |
| Healthcare && Dental Application |
|
|
| UPMC
2024 Preventive Schedule |
| Highmark
2024 Preventive Schedule |
| PPO
Blue 1500Q Benefits Grid |
| Health
Care Insurance Rebate Form |
| Medco
Mail Order Pharmacy Handbook |
| Prescription
Reimbursement Form |
| HighMark HRA Reimbursement Form |
| Medco
By Mail Order Form |
| Blue
Card Global Info
|
| Health Advocate
1-866-695-8622 |
|
| |
Dental
United
Concordia 1-800-332-0366 |
| Concordia
Network Dental Plan Policy |
| Concordia
Dental Benefits Summary 2024 |
Concordia
Dental ID Card Update |
| |
| Health
Savings Plans RHS
Plan - Mission Square - 1-800-290-7158 https://www.missionsq.org/ |
| Mission Square RHS Enrollment
Form |
| |
| Vision
1-800-432-4966
www.vbaplans.com/vision/
|
| |
| Vision
Care (Admin, Clerical, Police, Library) |
| Group
Vision Care Summary |
Vision
Benefits of America Enrollment |
| |
| Vision
Care (Public Works, Refuse) |
| Vision
Care Summary |
Vision
Benefits of America Enrollment |
|
| |
| Legal Shield |
Representative Contact: Lorraine Backus 330-784-2917
Or by Email at backus50@gmail.com
Employee Weblink: Legal Shield Benefits
|
| LegalShield Benefits
|
| EAP Program |
Employee Assistance Program |
| EAP Program Description |
EAP Program |
| |
| TAP 529 Tuition Program |
Contact: 800-440-4000 |
| Tap 529 Payroll Deduction Form |
| |
| Washington National |
Website: WashingtonNational.com |
POC: Zachary Smith |
Phone: 304-588-9656 |
Email: Zachary.Smith@optavise.com |
| |
| Aflac |
POC: Dan Marcin 412-826-1840 |
Website: Aflac.com |
| |
| |
| |
